Basic Information
| Provider Information | |||||||||
| NPI: | 1235312299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANSON | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3591 MCKINNEY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MELISSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754549571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728371075 | ||||||||
| FaxNumber: | 9728374120 | ||||||||
| Practice Location | |||||||||
| Address1: | 3591 MCKINNEY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MELISSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754549571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728371075 | ||||||||
| FaxNumber: | 9728374120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA02649 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.